Dobutamine Withdrawal

Abstract

While acute positive inotropic/vasopressor support (e.g. dobutamine, dopamine) is frequently employed as a “pharmacologic bridge” to definitive diagnostic/therapeutic intervention (e.g. catheterization followed by coronary revascularization, cardiac valve surgery), these agents are commonly needed to bring a patient through an acute non-surgically curable event (acute myocardial infarction or myocarditis, sepsis) or through a decompensation period of a chronic illness (e.g. decompensated dilated cardiomyopathy). It is in these patients that the problem of hemodynamic dependence to dopamine or dobutamine occurs. Basically, these patients are placed on these supportive agents to improve and stabilize hemodynamics and the clinical condition and then become very symptomatic during the withdrawal of the infusions. The same situation arises in some patients with advanced congestive heart failure (functional class IV, New York Heart Association) who undergo intermittent dobutamine infusions as part of their very advanced stage of therapeutics [1–3]. Our laboratory studies and clinical experience have focused primarily on the withdrawal of dobutamine and thus, dobutamine will serve as the drug of interest for the following discussion; but many of the points and principles to be presented relative to dobutamine withdrawal likely apply to the withdrawal of other cardiovascular-active compounds as well.